In the past two decades, use of home care services and the sector itself have grown rapidly. Between 1987 and 1997, Medicare’s spending for home care rose at an annual rate of 21%, and home care’s share of total Medicare expenditures increased from 2% to 9% (11). During this time, the number of agencies certified by Medicare and the number of patients served annually doubled. In 1997, home health care cost Medicare $16.7 billion and served approximately 4 million Medicare enrollees, most of whom (85%) received skilled nursing care (9–11). Federal projections through 2008 estimate that the cost of home health care services will rise at a faster rate than the economy (12). Factors fueling this rapid growth include increased size and longevity of the elderly population, shorter hospital stays, expansion of Medicare eligibility, and technological advances allowing delivery of more complex care in the home (11).